Feasibility and Outcome of an Accelerated Recovery Protocol in Asian Adolescent Idiopathic Scoliosis Patients

Chan, Chris Yin Wei; Loo, Shweh Fern; Ong, Jun Yin; Lisitha, Kulathunga Arachchige; Hasan, Mohd Shahnaz; Lee, Chee Kean; Chiu, Chee Kidd; Kwan, Mun Keong

doi:10.1097/brs.0000000000002206

Cited by 28 publications

(49 citation statements)

References 26 publications

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“…There was no difference in 30-day readmission rates between the groups. Chan et al 8 examined the feasibility and outcome of an accelerated recovery protocol in 74 adolescents undergoing PSF for correction of idiopathic scoliosis. Fixed discharge criteria were set, and postoperative recovery milestones were established to address the removal of urinary catheters and subfascial drains, as well as timing of dressing changes, mobilization, and PCA discontinuation.…”

Section: Correction Of Scoliosis and Spinal Deformitymentioning

confidence: 99%

Enhanced recovery after spine surgery: a systematic review

Elsarrag¹,

Soldozy²,

Patel³

et al. 2019

Neurosurgical Focus

180

113

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OBJECTIVEEnhanced recovery after surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty- and procedure-specific evidence-based protocols. The literature provides evidence of the benefits of ERAS implementation, which include expedited functional recovery, decreased postoperative morbidity, reduced costs, and improved subjective patient experience. Although extensively examined in other surgical areas, ERAS principles have been applied to spine surgery only in recent years. The authors examine studies investigating the application of ERAS programs to patients undergoing spine surgery.METHODSThe authors conducted a systematic review of the PubMed and MEDLINE databases up to November 20, 2018.RESULTSTwenty full-text articles were included in the qualitative analysis. The majority of studies were retrospective reviews of nonrandomized data sets or qualitative investigations lacking formal control groups; there was 1 protocol for a future randomized controlled trial. Most studies demonstrated reduced lengths of stay and no increase in rates of readmissions or complications after introduction of an ERAS pathway.CONCLUSIONSThese introductory studies demonstrate the potential of ERAS protocols, when applied to spine procedures, to reduce lengths of stay, accelerate return of function, minimize postoperative pain, and save costs.

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Section: Correction Of Scoliosis and Spinal Deformitymentioning

confidence: 99%

Enhanced recovery after spine surgery: a systematic review

Elsarrag¹,

Soldozy²,

Patel³

et al. 2019

Neurosurgical Focus

180

113

View full text Add to dashboard Cite

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“…There are technical differences amongst various studies regarding postoperative protocols but the common aim was to restore the patient's homeostasis early by managing pain efficiently, permitting early mobilization, and aiming for early discharge so as to reduce the length of hospital stay, avoid complications and reduce the burden on the health care system [12,15,18]. On the day of surgery, morphine Patient Controlled Analgesia (PCA) with IV diazepam was utilized for pain control and patients were encouraged to sit upright at the edge of the bed [14][15][16][17]19].…”

Section: Postoperative Protocolmentioning

confidence: 99%

“…Once patients were able to get out of bed under supervision, the indwelling urinary catheter was removed and patients encouraged to walk to the bathroom for toileting needs [16][17][18]. Pain management nurses recorded pain scores on a daily basis to ensure adequate pain control [18,19]. On post-operative day two until discharge, PCA was invariably discontinued and oral analgesics commenced as per the center specific pain management protocol [12][13][14][15][16][17][18][19].…”

Section: Postoperative Protocolmentioning

confidence: 99%

“…Pain management nurses recorded pain scores on a daily basis to ensure adequate pain control [18,19]. On post-operative day two until discharge, PCA was invariably discontinued and oral analgesics commenced as per the center specific pain management protocol [12][13][14][15][16][17][18][19]. There was conflicting literature on the use and duration of a drain [14,18].…”

Section: Postoperative Protocolmentioning

confidence: 99%

“…On post-operative day two until discharge, PCA was invariably discontinued and oral analgesics commenced as per the center specific pain management protocol [12][13][14][15][16][17][18][19]. There was conflicting literature on the use and duration of a drain [14,18]. If utilized, all the sub-fascial drains were removed and patients encouraged to sit up in a chair and undertake independent short walks and if possible climb a flight of stairs [16,19].…”

Section: Postoperative Protocolmentioning

confidence: 99%

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Enhanced recovery after surgery (ERAS) in adolescent idiopathic scoliosis (AIS): a meta-analysis and systematic review

et al. 2021

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Study design A systematic review reporting on the efficacy of an ERAS protocol in patients undergoing spinal fusion for AIS. Objective To systematically evaluate the relevant literature pertaining to the efficacy of ERAS protocols with respect to the length of stay, complication, and readmission rates in patients undergoing posterior spinal corrective surgery for AIS. Summary of background data ERAS is a multidisciplinary approach aimed at improving outcomes of surgery by a specific evidence-based protocol. The rationale of this rapid recovery regimen is to maintain homeostasis so as to reduce the postoperative stress response and pain. No thorough review of available information for its use in AIS has been published. Methods A systematic review of the English language literature was undertaken using search criteria (postoperative recovery AND adolescent idiopathic scoliosis) using the PRISMA guidelines (Jan 1999-May 2020). Isolated case reports and case series with < 5 patients were excluded. Length of stay (LOS), complication and readmission rates were used as outcome measures. Statistical analysis was done using the random effects model. Results Of a total of 24 articles, 10 studies met the inclusion criteria (9 were Level III and 1 of level IV evidence) and were analyzed. Overall, 1040 patients underwent an ERAS-type protocol following posterior correction of scoliosis and were compared to 959 patients following traditional protocols. There was a significant reduction in the length of stay in patients undergoing ERAS when compared to traditional protocols (p < 0.00001). There was no significant difference in the complication (p = 0.19) or readmission rates (p = 0.30). Each protocol employed a multidisciplinary approach focusing on optimal pain management, nursing care, and physiotherapy. Conclusion This systematic review demonstrates advantages with ERAS protocols by significantly reducing the length of stay without increasing the complications or readmission rates as compared to conventional protocols. However, current literature on ERAS in AIS is restricted largely to retrospective studies with non-randomized data, and initial cohort studies lacking formal control groups. Level of evidence 3.

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